经尿道前列腺切除治疗晚期前列腺癌并膀胱出口梗阻的疗效分析

目的:探讨经尿道前列腺切除在晚期前列腺癌并膀胱出口梗阻(BOO)治疗中的作用,分析经尿道前列腺切除对患者生存时间及生活质量的影响。方法:对2001～2004年间诊断为晚期前列腺癌并BOO的患者223例进行回顾性分析,根据治疗方法分为手术组(经尿道前列腺切除加内分泌治疗)127例,单纯内分泌治疗组96例。分别在术后3、12、24个月对两组患者的IPSS评分、最大尿流率、PSA、剩余尿量、疾病相关死亡和进展人数进行统计分析。结果:手术组IPSS评分和最大尿流率在术后3个月明显低于单纯内分泌治疗组(P<0.05)。两组患者在各时间点上的PSA、剩余尿量、疾病相关死亡人数和疾病进展人数的差异无统计学意义。手术组术后有不同比例的尿道狭窄、血尿、尿路感染和尿失禁发生。结论:经尿道前列腺切除加内分泌治疗晚期前列腺癌并BOO的患者,在短期内可以迅速降低IPSS评分,提高尿流率,改善生活质量;远期效果与单纯内分泌治疗相当。同时,手术本身也可能带来一些并发症,困扰患者的正常生活。

Long-term outcome of transurethral resection of prostate in patients with advanced prostate cancer and bladder outlet obstruction

Objective:To determine the efficacy of transurethral surgery in the treatment of patients with advanced prostate cancer and bladder outlet obstruction.Methods:From 2001 to 2004, 223 cases of patients with advanced prostate cancer were enrolled in this study. According to different therapy, these patients were divided into 2 groups: operation group (transurethral resection of prostate together with endocrinal therapy) and simple endocrinal therapy group. IPSS, Maximum flow rate, PSA value, residual volume; disease-associated mortality and disease-associated progression were evaluated by statistics at the time of 3,12 and 24 month.Results:IPSS in operation group was significantly lower than that in simple endocrinal therapy group at the time of 3 month, furthermore, maximum flow rate was higher than that in endocronal therapy group significantly after transurethral surgery. There were no differences between these 2 groups in the items of PSA value, residual volume, disease-associated mortality and disease-associated progression. However, some complications of transurethral surgery such as urethral stricture, hematuria, urinary infection and incontinence were found after several months of therapy and bother the quality of patients' life.Conclusions:Transurethral resection of prostate was believed to better quality of life by reducing IPSS and increasing maximum flow rate in the early period postoperatively. The long-term outcome was similar between these 2 groups. However, the complication caused by operation itself might raise the trouble in some patients.